超声心动图评估三尖瓣环：三维效应和测量方法。
Echocardiographic Assessment of the Tricuspid Annulus: The Effects of the Third Dimension and Measurement Methodology.
机构信息
Cardiac Imaging Center, University of Chicago Medical Center, Chicago, Illinois; Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy.
Cardiac Imaging Center, University of Chicago Medical Center, Chicago, Illinois.
出版信息
J Am Soc Echocardiogr. 2019 Feb;32(2):238-247. doi: 10.1016/j.echo.2018.09.008. Epub 2018 Nov 17.
BACKGROUND
Evaluation of the tricuspid annulus is crucial for the decision making at the time of left heart surgery. Current recommendations for tricuspid valve repair are based on two-dimensional (2D) transthoracic echocardiography (TTE), despite the known underestimation compared with three-dimensional (3D) echocardiography. However, little is known about the differences in 3D tricuspid annular (TA) sizing using TTE versus transesophageal echocardiography (TEE). The aims of this study were to (1) compare 2D and 3D TA measurements performed with both TTE and TEE and (2) compare two 3D methods for TA measurements: multiplanar reconstruction (MPR) and dedicated software (DS) designed to take into account TA nonplanarity.
METHODS
Seventy patients underwent 2D and 3D TTE and TEE. Two-dimensional images were used to measure TA diameter from apical four-chamber, right ventricular-focused (TTE), and midesophageal four-chamber (TEE) views. Three-dimensional full-volume data sets were analyzed using both MPR and DS, to obtain major and minor axes, perimeter, and area. Intertechnique agreement was assessed using Bland-Altman analysis.
RESULTS
Measurements on 2D TTE and TEE, which were view dependent, underestimated TA major dimensions in all views compared with 3D values, irrespective of the 3D method. MPR and DS measurements were significantly different, with DS resulting in larger values for all parameters, irrespective of approach. No differences were found between 3D TTE and 3D TEE for both MPR and DS.
CONCLUSIONS
Our findings highlight the need for methodology that respects the 3D geometry of the tricuspid annulus, including its nonplanarity, which cannot be accurately assessed from 2D images and is not equally taken into account by different 3D measurement methodologies. Accordingly, a 3D cutoff value for TA enlargement needs to be established and is likely to be larger than the guideline-recommended 2D-based 40-mm cutoff. Importantly, noninvasive 3D TTE can be used instead of 3D TEE because TA measurements are not different.
背景
评估三尖瓣环对于左心手术决策至关重要。目前，三尖瓣修复的推荐基于二维（2D）经胸超声心动图（TTE），尽管与三维（3D）超声心动图相比存在明显低估。然而，关于 TTE 与经食管超声心动图（TEE）测量 3D 三尖瓣环（TA）大小的差异知之甚少。本研究的目的是：（1）比较 TTE 和 TEE 测量的 2D 和 3D TA 测量值；（2）比较两种用于 TA 测量的 3D 方法：多平面重建（MPR）和专用软件（DS），旨在考虑 TA 的非平面性。
方法
70 例患者接受 2D 和 3D TTE 和 TEE 检查。二维图像用于从心尖四腔、右心室聚焦（TTE）和食管中段四腔（TEE）视图测量 TA 直径。使用 MPR 和 DS 分析 3D 全容积数据集，以获得长轴和短轴、周长和面积。采用 Bland-Altman 分析评估技术间一致性。
结果
2D TTE 和 TEE 的测量值与 3D 值相比，在所有视图中均受视图依赖性影响，低估了 TA 主要尺寸，无论使用哪种 3D 方法。MPR 和 DS 测量值存在显著差异，DS 导致所有参数值均较大，无论方法如何。对于 MPR 和 DS，3D TTE 和 3D TEE 之间无差异。
结论
我们的研究结果强调需要一种方法来尊重三尖瓣环的 3D 几何形状，包括其非平面性，从 2D 图像无法准确评估，并且不同的 3D 测量方法也无法平等地考虑到这一点。因此，需要建立一个 TA 扩大的 3D 截止值，并且很可能大于指南推荐的基于 2D 的 40mm 截止值。重要的是，由于 TA 测量值没有差异，因此可以使用非侵入性 3D TTE 代替 3D TEE。
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